Clin Mol Hepatol.  2012 Jun;18(2):213-218. 10.3350/cmh.2012.18.2.213.

The clinical features of drug-induced liver injury observed through liver biopsy: focus on relevancy to autoimmune hepatitis

• Ju HY
• Jang JY
• Jeong SW
• Woo SA
• Kong MG
• Jang HY
• Lee SH
• Kim SG
• Cha SW
• Kim YS
• Cho YD
• Jin SY
• Kim HS
• Kim BS

• KMID: 1743729
• DOI: http://doi.org/10.3350/cmh.2012.18.2.213

Abstract

BACKGROUND/AIMS
Accurate diagnosis of drug-induced liver injury (DILI) is difficult without considering the possibility of underlying diseases, especially autoimmune hepatitis (AIH). We investigated the clinical patterns in patients with a history of medication, liver-function abnormalities, and in whom liver biopsy was conducted, focusing on accompaniment by AIH.
METHODS
The clinical, serologic, and histologic findings of 29 patients were compared and analyzed. The patients were aged 46.2+/-12.8 years (mean+/-SD), and 72.4% of patient were female. The most common symptom and causal drug were jaundice (58.6%) and herbal medications (55.2%), respectively.
RESULTS
Aspartate aminotransferase (AST), alanine aminotransferase, total bilirubin, alkaline phosphatase, and gamma-glutamyl transpeptidase levels were 662.2+/-574.8 U/L, 905.4+/-794.9 U/L, 12.9+/-10.8 mg/dL, 195.8+/-123.3 U/L, and 255.3+/-280.8 U/L, respectively. According to serologic and histologic findings, 21 cases were diagnosed with DILI and 8 with AIH. The AIH group exhibited significantly higher AST levels (537.1+/-519.1 vs. 1043.3+/-600.5 U/L), globulin levels (2.7+/-0.4 vs. 3.3+/-0.5 g/dL), and prothrombin time (12.9+/-2.4 vs. 15.2+/-3.9 s; P<0.05). Antinuclear antibody was positive in 7 of 21 cases of DILI and all 8 cases of AIH (P=0.002). The simplified AIH score was 3.7+/-0.9 in the DILI group and 6.5+/-0.9 in the AIH group (P<0.001).
CONCLUSIONS
Accurate diagnosis is necessary for patients with a history of medication and visits for liver-function abnormalities; in particular, the possibility of AIH should be considered.

Keyword

Drug-induced liver injury; Autoimmune hepatitis; Diagnosis

MeSH Terms

Adult
Alanine Transaminase/blood
Antibodies, Antinuclear/blood
Aspartate Aminotransferases/blood
Biopsy
Drug-Induced Liver Injury/*diagnosis/pathology
Female
Globulins/analysis
Hepatitis, Autoimmune/*diagnosis/pathology
Herbal Medicine
Humans
Jaundice/etiology
Male
Middle Aged
Prothrombin Time